ICD-10

Parafilie wiążą się z podnieceniem seksualnym wywołanym u jednostki w przypadku wystąpienia określonych obiektów lub sytuacji, które nie są przedmiotem normatywnej stymulacji seksualnej.
Ostatnie wydanie klasyfikacji zaburzeń psychicznych (DSM-V) Amerykańskiego Towarzystwa Psychiatrycznego wprowadziło rozróżnienie na parafilie i zaburzenia parafiliczne. Zaburzenie parafiliczne dotyczy parafilii, która powoduje szkody lub ograniczenia dla danej jednostki, lub takiej parafilii, której zaspokojenie naraża na cierpienie pacjenta lub innych osób.
Przedmiotem referatu jest przedstawienie konsekwencji diagnostycznych ostatnich rozwiązań wprowadzonych przez DSM-V, przedstawienie wybranych przypadków diagnostycznych oraz streszczenie dyskusji na temat traktowania parafilii jako zaburzeń psychicznych.

“Трансгендерность и трансфеминизм” – первая книга на русском языке, рассматривающая трансгендерность с точки зрения феминистской теории, а также одна из первых, посвящённых трансгендерности целиком. Книгу отличает непатологизирующий и небинарный подход. Обозревая как ранее выдвинутые в англоязычной литературе концепции, так и текущую постсоветскую повестку движения (в особенности его трансфеминистского направления), Яна Кирей-Ситникова анализирует такие темы, как: непатологизирующая небинарная терминология, проблемы циснормативности и трансфобии, взаимоотношения между транс* и феминистским движениями, интерсекциональность и концепция привилегий, домашнее насилие над трансгендерными людьми, принятие своего тела, теории формирования гендерной идентичности и модели депатологизации гендерной вариативности.

Die Expertise für den 13. Kinder- und Jugendbericht gibt einen Überblick über Versorgungsstrukturen und Inanspruchnahme bei psychischen Störungen von Kindern und Jugendlichen. Insbesondere werden auf der Basis einer aktuellen empirischen Untersuchung „gesundheitsbezogene Anlässe“ bei der Inanspruchnahme von Erziehungsberatung beschrieben. Ein eigenes Thema bildet die ICD-10-Kategorisierbarkeit von Problemen in der Erziehungsberatung. Dabei wird der diagnostische und therapeutische Ansatz der Erziehungsberatung in Abgrenzung zur Kinder- und Jugendpsychiatrie dargestellt. Auf der Grundlage der genannten Untersuchung werden schließlich die einzelfallbezogene und die einzelfallübergreifende Zusammenarbeit der Erziehungsberatung mit dem Gesundheitswesen beschrieben. Abschließend wird die Entwicklung der Erziehungsberatung in den letzten Jahren nach Inanspruchnahme, Personal und Kosten skizziert.

In 1992, the experts of the World Health Organization decided to introduce a new diagnostic category. Possession Trance became recognized as a psychiatric disorder. The introduction of this new category prompted the clarification of its diagnostic criteria. In an unprecedented way, the authors of the 10th edition of the International Classification of Disorders (ICD-10) made the diagnosis of possession trance dependent on the cultural context of its occurrence making the diagnostician-clinician responsible for determining the relations between the possession trance and its cultural environment.

En m’inspirant du cadre théorique du dispositif de sexualité élaboré par Michel Foucault, je propose de mettre à l’épreuve le concept de « santé sexuelle », institutionnalisé par l’Organisation mondiale de la santé (OMS) dans les années 1970, et dont l’usage depuis les années 1990 dans les politiques de santé publique à travers le monde n’a cessé de croître, à la faveur notamment de la lutte contre le VIH/SIDA, et de la commercialisation de médicaments pour traiter certains troubles de l’érection. La question que je souhaite poser est celle-ci : le concept de « santé sexuelle » participe-t-il d’un dispositif de sexualité ? Constitue-t-il, dès lors, un outil de biopouvoir ? Les éléments qui me conduisent à poser cette question sont les suivants : le fait que la sexualité soit appréhendée à travers le prisme de la santé ; le fait que la notion de « santé sexuelle » ait pu être associée, à l’occasion, à l’idée de vertu sexuelle, et soit aujourd’hui parfois associée à celle de sexualité saine ; et enfin, le fait que l’institution promouvant le concept de « santé sexuelle » sur le plan international édite par ailleurs une classification des maladies qui comprend des paraphilies, c’est-à-dire ce que l’OMS appelait auparavant des « perversions sexuelles ».

La sensibilità chimica multipla (MCS) è una malattia rara ancora poco chiara in letteratura. Con il termine “malattia rara” si intende l’insieme di patologie che colpiscono un numero di persone piuttosto ridotto, che indicativamente si orienta intorno ai 5 casi su 10.000. Ad oggi circa l’80% delle malattie rare ha un’origine genetica, mentre il 20% ha cause multifattoriali, come ad esempio cause ambientali, alimentari, ecc. (ISS).
La MCS (Multiple chemical sensitivity syndrome) nello specifico è una patologia cronica in cui il soggetto riporta una reazione avversa a sostanze chimiche di vario tipo in una misura straordinaria rispetto a quanto atteso nella norma. La MCS è tipica in alcuni soggetti esposti in maniera particolare a sostanze a rischio; tra questi: lavoratori industriali, agricoltori, parrucchieri, dipendenti sanitari, reduci della guerra del Golfo e così via. I sintomi della MCS sono piuttosto variegati e mutano molto in base alla loro severità. La MCS si caratterizza generalmente per: una sofferenza generalizzata; stanchezza cronica; difficoltà digestive o nausea; cefalea; disturbi respiratori; reazioni allergiche dermatologiche; difficoltà nel meno dell’umore. In alcuni casi la MCS appare in soggetti con precedente diagnosi di Fibromialgia, tantochè alcuni autori ipotizzano che MCS e fibromialgia siano in comorbidità tra loro.
Ad oggi ancora la diagnosi di MCS appare discussa. Non risulta infatti un evidente e univoco iter diagnosticato così come gli autori in letteratura non si trovano d’accordo sulla eziopatogenesi del disturbo.
Eppure è stato nel tempo dimostrato come sia fondamentale comprendere l’origine del proprio malessere per il paziente; solo comprendendo il proprio dolore il paziente è in grado di prenderne atto, diventarne consapevole e agire di conseguenza. Se il paziente, invece, non è messo al corrente di tutto questo capita di osservare in lui una scarsa compliance e una modalità indifferenziata di agire nel mondo (es. fobie generali, ansie ecc.).
Non sono molti gli studi che hanno cercato di indagare quali siano i vissuti psicologici del paziente con MCS, dal momento che ancora poco questo argomento e questa patologia sono state chiarite. Ad oggi sappiamo che, come accade per altre patologie, il paziente con MCS è un paziente che soffre a livello individuale e relazionale (es. difficoltà a mangiare con gli amici, fobie alimentari, ecc.).
Vista la scarsa coerenza dei dati in letteratura, la presente tesi cerca di approfondire l’argomento in maniera complessa, tenendo conto di numerose sfaccettature della patologia.
In particolare, all’interno del capitolo 1 si definirà la Sensibilità Chimica Multipla, offrendone uno spaccato sintomatologico ed eziopatogenetico. Prima di trattare la MCS verranno introdotte più in generale le malattie rare.
Nel capitolo 2 si tratterà del riconoscimento sociale e legale della MCS, approfondendo da un lato quanto sia importante per il paziente essere riconosciuto dalle persone intorno come persona “con patologia” (amici, partner, ecc.); dall’altro, approfondendo il riconoscimento legale, ovvero quanto sia fondamentale che al paziente vengano garantiti determinati diritti. In questa occasione verranno anche discussi i LEA (Livelli Essenziali di Assistenza) e i PDTA (Piano Terapeutico di Trattamento).
Nel capitolo 3 si discuteranno i vissuti psicologici del paziente con MCS, sia da un punto di vista individuale (ansia, depressione, ecc.) che relazionale (es. scarso riconoscimento, autostima, ecc.).
Infine nel capitolo 4 si tratterà il ruolo della presa in carico multidisciplinare dedicando un ampio spazio al contributo della medicina narrativa che è stata essenziale nel rivoluzionare la comprensione del paziente e della sua malattia.

BHS: Cilj ovog rada je prikaz slučaja imaginarnog lika, dr Hannibala Lectera, na osnovu analize sadržaja četiri knjige („Hannibal“, „Hannibal: postanak“, „Kad jaganjci utihnu“ i „Crveni zmaj“), četiri filma sa istoimenim nazivima i dvije sezone od po 13 epizoda serije „Hannibal“. U prvom dijelu, analiza se odnosi na razmatranje pomenutog slučaja uzimajući u obzir dijagnostičke kriterijume sljedećih klasifikacija bolesti: DSM-IV, DSM-V i ICD-10. Potom, ponuđena je deskripcija ličnosti dr Lectera kroz savremene modele strukture ličnosti: Model velikih pet, HEXACO model, Model velikih sedam, Dvofaktorski model i Jednofaktorski model. Posebno smo se osvrnuli na tumačenje bihevioralnih obrazaca ovog fiktivnog lika iz ugla klasičnih psihodinamskih teorija, te kroz prizmu teorijskog stanovišta Jacquesa Lacana. Dodatno, njegovo ponašanje je objašnjeno rukovodeći se postulatima kognitivno-bihevioralne paradigme, te evolucione psihologije. Na kraju rada, pobrojani su zaključci, nastali kao sinteza prethodnih interpretacija, odnosno eklektičkog pristupa korištenog prilikom pomenute analize. Istaknuti su i nedostaci ovakve vrste analize, u vidu metodoloških ograničenja kvalitativnog istraživanja na jednom ispitaniku (studije slučaja) i problema diferencijalne dijagnostike u slučaju kontroverznog lika kakav je dr Hannibal Lecter.
ENG: The aim of this study was to review the case of the imaginary character, Dr. Hannibal Lecter, based on content analysis of four books (“Hannibal”, “Hannibal Rising”,    “Silence of the Lambs”  and “Red Dragon”), four films with the same title and two seasons of 13 episodes of the serial “Hannibal”. In the first part, the analysis refers to the consideration of the aforementioned case, taking into account the following diagnostic classifications: DSM-IV, DSM-5 and ICD-10. Then, we offered a description of Dr. Lecter’s personality through modern models of personality structure: Big Five Model, HEXACO Model, The Big Seven Model, Two-factor Model and One-factor Model. In particular, we address the interpretation of behavioral patterns of this fictional character from the perspective of classical psychodynamic theory, and through the prism of a theoretical point of Jacques Lacan. In addition, his behavior is explained by applying the postulates of cognitive-behavioral paradigm as well as evolutionary psychology. At the end of the paper are listed conclusions, created as a synthesis of previous interpretations, or an eclectic approach used in these analyses. In addition, there are featured disadvantages of this type of analysis, in the form of methodological limitations of qualitative research in one subject (case studies) and problems of differential diagnosis in the case of a controversial character such as Dr. Hannibal Lecter.

Summary in English (article is in German):

The author wants to show that the application of the classification scheme ICD-10 (International Classification of Diseases, 10th Revision) can have manifold effects in the psychotherapeutic process. She pleads for a critical reflection of this application in practice, since it can quickly lead to obstructive thought patterns in communication with clients (but also with other colleagues and between occupational groups), if this is not consciously counteracted. To clarify her point of view, she presents two case vignettes, in each of which the classification according to ICD-10 plays a special role.

Zusammenfassung:

Die Autorin will aufzeigen, dass die Anwendung des Klassifikations-Schemas ICD-10 (Internationale Klassifikation der Krankheiten, 10. Revision) vielfältige Auswirkungen im psychotherapeutischen Prozess haben kann. Sie plädiert für eine kritische Reflexion dieser Anwendung in der Praxis, da sie in der Kommunikation mit Klientinnen (aber auch mit anderen Kolleginnen und zwischen den Berufsgruppen) rasch zu hinderlichen Denkschablonen führen kann, wenn dem nicht bewusst entgegengewirkt wird. Um ihren Standpunkt zu verdeutlichen, präsentiert sie zwei Fallvignetten, in denen die Klassifikation nach ICD-10 jeweils eine besondere Rolle spielt.

Post-Soviet space is underrepresented in international discussions on trans depathologization, and voices of trans people (as distinct from activists and experts) are rarely heard. The article seeks to fill this gap by introducing debates on depathologization among trans activists and nonactivist trans people of post-Soviet countries. In order to take into account opinions of various groups of trans people, a survey was conducted concerning the revision of the International Classification of Diseases and various trans-related policies. Classification models were developed to find relationships between demographic data and answers to the questions about depathologization and legal gender recognition.

Wprowadzenie:
Zmiany dokonane w kryteriach diagnozowania DSM -V w stosunku do DSM -IV powodują, że parafilia nie musi być diagnozowana jako zaburzenie a traktowana jako przejaw różnic indywidualnych w zakresie seksualności. Z uwagi na to, że kryteria diagnostyczne wykorzystywane są w praktyce biegłych sądowych seksuologów rodzi to określone implikacje dla sądownictwa.
Cel pracy:
Przedstawienie różnic w klasyfikowaniu zaburzeń parafilicznych między systemami ICD-10 i DSM –V oraz wskazanie jak te różnice mogą wpływać na opinie biegłych sądowych w dziedzinie seksuologii.
Wnioski:
Biegli sądowi dysponują różnymi kryteriami diagnostycznymi a ich wybór nie jest obligatoryjny. Stosowanie różnych systemów diagnostycznych prowadzi do różnic w formułowanych przez nich opiniach. Uznanie danej osoby za zaburzoną lub nie może zależeć od przyjętego systemu diagnostycznego. W sądownictwie jest to różnica, która może rozstrzygać o stwierdzeniu zachowania patologicznego bądź nie.
Ograniczenia metodologiczne:
Trudno formułować wnioski w sytuacji małej ilości dostępnego materiału badawczego. Opinie biegłych seksuologów trafiają do sędziego i nie są dostępne badaczom. Niewielu jest biegłych, którzy są jednocześnie praktykami i badaczami. Zbyt mało jest danych, które kryteria stosowane są częściej przez polskich biegłych sądowych w dziedzinie seksuologii, których dodatkowo jest niewielu.

RESUMEN Los trastornos del sueño son extraordinariamente frecuentes en los trastornos afectivos y, aunque en general se han considerado secundarios al trastorno afectivo en si, cabe preguntarse si en ocasiones se trata de un substrato común que produce ambos o incluso si es el trastorno del sueño el que produce la psicopatología afectiva. En el presente trabajo estudiamos el insomnio como queja subjetiva en una muestra constituida por 128 pacientes psiquiátricos ambulatorios consecutivos con diagnósticos incluidos en las categorías F3 (trastornos de humor; n = 58: edad media = 39,77 [ ± 13,281] y F4 (trastornos neuróticos; n = 70; edad media = 32,37 [ ± 12,541] del CIE-10 mediante el análisis de los items 44 (dificultad para conciliar el sueño), 64 (despertares de madrugada) y 66 (sueño inquieto o perturbado) del inventario autoadministrado SCL-90-R. Los pacientes pertenecientes a la categoría diagnóstica F3 obtienen valores significativamente mayores (p < 0,05), en los tres items, que los correspondientes a pacientes incluidos en la categoría diagnóstica F4, y esto ocurre fundamental-mente a expensas de las mujeres de ambas categorías di-agnósticas. Ninguno de los items experimentó correlacio-nes significativas con la edad en las categorías de la muestra, hecho éste, que contrasta con los resultados correspondientes a lo que ocurre en la población general del mismo medio.
SUMMARY Sleep Disorders are particularly frequent in affective disorders. Although they have been considered as secondary to the existing affective disorder, we can think whether there is a common basis that generates both phenomena. Moreover, it could be thought that sleep disorders could induced the very affective disorder. In this study, insomnia subjective complaints in a sample of 128 psychiatric consecutive outpatients with F3 category diagnosis (n = 58; mean age = 39,77 [ ± 13,28]) and F4 category diagnosis (n = 70; mean age = 32.54 [ ± 12,54]) are considered. Items 44, 64 and 66 of Derogatis SCL-90-R Self-report questionnaire, that have to do with insomnia complaints, are analysed. F3 diagnostic category patients manifest significant higher values (p < 0,05) than the patients from the F4 category diagnosis in each of the three items considered. Mainly women are responsible of the higher scores observed in F3 diagnostic category patients. No significant correlations with age was observed in any of the items studied. This fact strongly contrasts with the results registered by general population in our context.

С чем связана существующая в настоящее время «многожанровость» психиатрических текстов? Почему определение терминов в психиатрии должно быть операциональным? Для чего необходим частый пересмотр операциональных классификационных схем?  Каковы закономерности формирования терминосистем научных дисциплин? В статье проводится анализ  исторического контекста развития идей операционализма в философии, науке, менеджменте (управлении медицинскими услугами). Так же рассматриваются некоторые закономерности существования терминов и дефиниций  с позиций общей терминологии.

O remarcabila introducere in istoria conceptului de persoana si a psihologiei persoanei, metodologia diagnosticului si instrumentele actuale de evaluare, tratamentul tulburarilor de personalitate, careia autorii ii adauga o perspectiva etica asupra acestor disfunctii, fapt ce contureaza sensul antropologic general al demersului lor. Tulburarile de personalitate sint expuse din perspectiva categoriala(in conformitate cu criteriile internationale DSM-IV si    ICD-10) si dimensionala, realizindu-se o caracterizare generala a acestora.

Healthcare infrastructure and all related support activities has been stretched globally beyond comprehension owing to COVID 19. Trained resources to manage healthcare has been in short supply and this scenario has affected even backend operations, which is a very vital component to ensure seamless operations of healthcare chain. Even while all-out effort is being made to scramble for solutions, outsourcing backend work is gaining prominence. This is where the relevance of Health Information Management (HIM) assumes great importance. The Heath Information management industry helps the healthcare sector in many ways. It keeps a constant check on whether patients are served in the right way. It sees to it that there are no medical mistakes, high drug safety, no fragmented delivery systems and high quality of information system is maintained. Medical Coding and capturing the required data elements are key for HIM. Medesun, Pioneers in medial coding in India, provides training, consulting for HIM champions, prospective HIM fellows. COVID-19 and Mucormycosis Medical Coding-2021 Code U07.1, COVID-19, is assigned only if the provider documentation either specifically documents a confirmed diagnosis of the COVID-19 Pneumonia due to COVID-19: Assign codes U07.1 and J12.89, Other viral pneumonia. Acute bronchitis due to COVID-19: Assign codes U07.1 and J20.8, Acute bronchitis due to other specified organisms. Bronchitis not otherwise specified (NOS) due to COVID-19: Assign codes U07.1 and J40, Bronchitis, not specified as acute or chronic. COVID-19 with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS: Assign codes U07.1 and J22, Unspecified acute lower respiratory infection. COVID-19 associated with a respiratory infection, NOS: Assign codes U07.1and J98.8, Other specified respiratory disorders. Acute respiratory distress syndrome (ARDS) due to COVID-19: Assign codes U07.1 and J80, Acute respiratory distress syndrome.

Modified national versions of the WHO's International Statistical Classification of Diseases, current version ICD-10 with ICD-11 coming into effect in January 2022, have become the standard in many countries for diagnosis and procedure coding to facilitate the submission of medical billing and reimbursement by health insurers. The WHO ICD-10 exists purely as a coded classification of disease. It has no related classification of procedures and lacks the clinical level of diagnostic specificity necessary for the documentation of individual clinical cases and the associated prescribed therapies and interventions, particularly surgical cases. Historically, the US clinical modification of ICD-9, known as ICD-9-CM, established the trend. Australia adopted ICD-9-CM, later adapted it to Australian clinical specifications, and after the launch of the WHO ICD-10 produced the current Australian modification ICD-10-AM, used under license by many other countries. This paper examines a work in progress, rather than offering an academic critique, to illustrate the evolution of national clinical modications with particular reference to those of the United States, Australia and Thailand. The selection is based on the historical ICD-9-CM connection of the US and Australia, and the fact that Thailand is a more advanced developing nation like Saudi Arabia. The study parameters include the Saudi national healthcare system which has not previously employed a classification clinical coding, despite the wealthy developing healthcare system. Nations using their own modification face the burden of upgrading. Saudi Arabia plans to implement the national Australian modification, rather than creating a Saudi national modification.

UPT Puskesmas Benteng merupakan instansi pemerintahan yang termasuk ke kategori unit pelaksana teknis dinas kesehatan kota atau kabupaten Indragiri Hilir provinsi Riau yang bertanggung jawab dalam pengembangan kesehatan pada suatu wilayah kerja. UPT Puskesmas Benteng dibantu 8 puskesmas pembantu yang mengatur pelayanan tiap wilayah yang ada di Benteng. Kegiatan pelayanan yang diselenggarakan pada puskesmas adalah pelayanan pendataan pasien, pendataan asuhan dan laporan sepuluh penyakit terbanyak setiap bulannya untuk dilaporkan kepada dinas kesehatan. Untuk saat ini pengelolaan layanan tersebut masih dilakukan secara manual yang dibuat dalam buku besar dan di ketik menggunakan Microsoft Excel. Sehingga banyak data yang bersifat ganda maupun kehilangan data yang mengakibatkan pembuatan laporan memakan waktu lama dan kurangnya keakuratan data laporan. Oleh karena itu sistem pendataan pasien dan laporan puskesmas pembantu UPT Puskesmas Benteng ini dibangun untuk mempermudahkan pendataan dan pembuatan laporan tersebut. Berdasarkan hasil pengujian menggunakan Black Box memberikan hasil sistem berjalan dengan sangat baik dan User Acceptance Test (UAT) memberikan hasil “Sangat Setuju”dengan persentasi range 81%-100%.

Background: Researchers and clinicians within the field of trauma have to choose between different diagnostic descriptions of posttraumatic stress disorder (PTSD) in the DSM-5 and the proposed ICD-11. Several studies support different competing models of the PTSD structure according to both diagnostic systems; however, findings show that the choice of diagnostic systems can affect the estimated prevalence rates. Objectives: The present study aimed to investigate the potential impact of using a large (i.e. the DSM-5) compared to a small (i.e. the ICD-11) diagnostic description of PTSD. In other words, does the size of PTSD really matter? Methods: The aim was investigated by examining differences in diagnostic rates between the two diagnostic systems and independently examining the model fit of the competing DSM-5 and ICD-11 models of PTSD across three trauma samples: university students (N = 4213), chronic pain patients (N = 573), and military personnel (N = 118). Results: Diagnostic rates of PTSD were significantly lower according to the proposed ICD-11 criteria in the university sample, but no significant differences were found for chronic pain patients and military personnel. The proposed ICD-11 three-factor model provided the best fit of the tested ICD-11 models across all samples, whereas the DSM-5 seven-factor Hybrid model provided the best fit in the university and pain samples, and the DSM-5 six-factor Anhedonia model provided the best fit in the military sample of the tested DSM-5 models. Conclusions: The advantages and disadvantages of using a broad or narrow set of symptoms for PTSD can be debated, however, this study demonstrated that choice of diagnostic system may influence the estimated PTSD rates both qualitatively and quantitatively. In the current described diagnostic criteria only the ICD-11 model can reflect the configuration of symptoms satisfactorily. Thus, size does matter when assessing PTSD.

For more than a decade, research studies on the various personality disorders have been carried out at an ever-expanding pace (Blashfield and McElroy, 1987; Gorton and Akhar, 1990). Factors promoting this research have  included the establishment within the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of a separate axis for the diagnosis of personality disorders, the enumeration within DSM-III of diagnostic criteria for these conditions, and the development of standardized interviews for the assessment of personality disorders.  Innovations such as these are expected to advance the scientific stature of personality disorder research.

There is no effort to build Human Recourse capacity and Training for implementation of the NHI in South Africa . There is a current Commission on Stardization to harmonize pricing across the General Practitioner (the primary health system of Private Sector), The GP contracting to register on NHI is  rejected by the GP and Specialist, because according to International practice. South Africa is far  from ratio of the  Daily Number of Patient and Doctors & Specialist .  The 10 Causes of Morbidity and Mortality in the public Sectors & Quantifying these t provide evidence that will inform the Minimum Proscribed Benefits and Risk to NHI Fund was not established using the Public sector data where patients bout inpatients 7 Outpatients have not been determined.

La propuesta oficial de establecer una “incongruencia de género en la infancia” amenaza como último bastión de la patologización de las infancias trans* y también, me atrevo a decir, de una expresión de género que atañe a cientos de miles de chonguitas y mariconcitos –por mencionar recientes contranarrativas de memorias de la infancia– que viven y experimentan sus vidas en los márgenes coercitivos de la diferencias sexual y su compulsión hetero-centrada. ¿Estamos ante una nueva re-patologización de la orientación sexual y expresión de género?


Theumer Emmanuel, “ICD 11:HA61. Luchas abiertas por la despatologización” en Elena Victoria Acevedo de Bomba; Silvio Alexis Lucena (comp.) Educación y política: en el camino hacia un nuevo humanismo, San Miguel de Tucumán : Editorial Humanitas-Universidad Nacional de Tucumán, 2020. pp. 105-112. ISBN 978-987-754-236-3

The classification of mental illness and disorder has been a contentious endeavor of psychologists and psychiatrists over the last two centuries. The American Psychiatric Association provided for this task The Diagnostic and Statistical Manual of Mental Disorders (DSM), with successive additions over the last 60 years. Likewise, the World Health Organization (WHO), an agency of the United Nations, published the International Classification of Diseases (ICD). The Mental Health Programme of the WHO became actively engaged in the development of a classification and diagnoses of mental disorders in the 1960’s, which became codified and published in the eighth edition of the ICD. Limitations of both manuals still reflect the shortcomings of the American and Worldwide mental health systems.

BACKGROUND: The temporal stability of a diagnosis is one measure of its predictive validity.

AIMS: To measure diagnostic stability in first-episode psychosis using ICD-10 and DSM-III-R.

METHOD: Between 1992 and 1994 we ascertained a cohort of persons with first-episode psychosis (n = 168), assigning to each a consensus diagnosis. At three-year follow-up, longitudinal consensus diagnoses, blind to onset diagnoses, were made. Stability was measured by the positive predictive values (PPVs) of onset diagnoses. For onset schizophrenia, we also calculated sensitivity, specificity and concordance (kappa).

RESULTS: First-episode ICD-10 and DSM-III-R schizophrenia had a PPV of over 80% at three years. Over one-third of cases with ICD-10 F20 schizophrenia at three years had non-schizophrenia diagnoses at onset. Manic psychoses showed the highest PPV (91%). For onset schizophrenia, both systems had high specificity (ICD-10: 89; DSM-III-R: 93%), but low sensitivity (ICD-10: 64%; DSM-III-R: 51%) and moderate concordance (ICD-10: 0.54; DSM-III-R: 0.46).

CONCLUSIONS: Bipolar disorders and schizophrenia showed the highest stability. DSM-III-R schizophrenia did not have greater stability than ICD-10 schizophrenia.

Background and Objectives: The use of “operational criteria” is a solution for low
reliability, contrasting with a prototypical classification that is used in clinics. We aim to
measure the reliability of prototypical and ICD-10 diagnoses.
Methods: This is a retrospective study, with a convenience sample of subjects treated in
a university clinic. Residents reviewed their diagnosis using ICD-10 criteria, and Cohen’s
kappa statistic was performed on operational and prototype diagnoses.
Results: Three out of 30 residents participated, reviewing 146 subjects under their
care. Diagnoses were grouped in eight classes: organic (diagnoses from F00 to F09),
substance disorders (F10–F19), schizophrenia spectrum disorders (F20–F29), bipolar
affective disorder (F30, F31, F34.0, F38.1), depression (F32, F33), anxiety-related
disorders (F40–F49), personality disorders (F60–F69), and neurodevelopmental disorders
(F70–F99). Overall, agreement was high [K = 0.77, 95% confidence interval
(CI) = 0.69–0.85], with a lower agreement related to personality disorders (K = 0.58,
95% CI = 0.38–0.76) and higher with schizophrenia spectrum disorders (K = 0.91, 95%
CI = 0.82–0.99).
Discussion: Use of ICD-10 criteria did not significantly increase the number of
diagnoses. It changed few diagnoses, implying that operational criteria were irrelevant
to clinical opinion. This suggests that reliability among interviewers is more related to
information gathering than diagnostic definitions. Also, it suggests an incorporation
of diagnostic criteria according to training, which then became part of the clinician’s
prototypes. Residents should be trained in the use of diagnostic categories, but
presence/absence checking is not needed to achieve operational compatible diagnoses.